Pelvic exenteration for women
Pelvic exenteration is a major operation – it can be used to treat cancer in the pelvis.
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Pelvic exenteration is an operation (surgery) to remove multiple organs in the pelvis. The internal reproductive organs (the ovaries, womb, cervix and vagina) are removed.
Depending on the type of pelvic exenteration the surgeon may also remove:
- the bladder
- part of the lower bowel (rectum)
- both the bladder and the rectum.
The operation is sometimes called pelvic clearance.
We have more information about types of pelvic exenteration.
Before the operation you will be referred to a specialist cancer nurse. They will give you information and emotional support.
This operation can be done to treat cancers in the pelvis, including:
It can be used when cancer has spread within the pelvis, or has come back in the pelvis after other treatment. Pelvic exenteration is most often used to treat cervical cancer that has come back after treatment.
Pelvic exenteration is a major operation. It is only suitable for a small number of people. Together, you and your healthcare team will decide whether the operation is right for you. As part of this process you will:
- have tests to check you can cope with the operation
- talk to your healthcare team about any concerns you have.
If you consent to have the operation, you will go to a specialist centre to meet with a team of specialists involved in your care.
We have more information about what happens before this operation.
Pelvic exenteration usually takes about 8 hours, but it can take longer. Two or more surgeons will work together. These could include:
- a urologist – a surgeon who specialises in the urinary system
- a colorectal surgeon – a surgeon who specialises in bowel cancers
- a plastic surgeon – a surgeon who specialises in reconstruction.
After your operation you will be in an intensive care or high-dependency unit for the first few days. You will probably stay in hospital for 2 to 3 weeks.
When you wake up after the operation, you will have dressings on your wounds from the surgery. You may also have drips and drains.
After a few days, you will be able to start to care for your own stoma and change the bag. Your stoma nurse will give you information and support to help you adjust.
When you go home, you will need extra help and support for a few weeks. Before your surgery, tell the hospital staff or your specialist nurse if you are worried about managing at home. They can arrange help for you.
When you go home you will have injections to thin the blood and reduce the risk of blood clots.
You may find it takes several months after surgery to recover. As time goes on, you will start to feel stronger and have more energy.
We have more information about what happens after pelvic exenteration.
The physical changes to your body after the operation (surgery) can mean changes to your sex life. How the operation affects you physically and emotionally will vary. You may need to make some adjustments. Your surgeon and specialist nurse will talk to you about the changes you may have. It can help to talk about any questions or worries you have.
We have more information about:
- cancer and your sex life, including tips on talking to your healthcare team and coping with your feelings.
- female pelvic changes and sex. This includes changes in sensation, bladder problems and changes to the anus or rectum.
- sex and side effects of cancer treatment, which includes coping with a stoma.
- body image, if you are worried about changes to your appearance.
You may not feel like having sex for a while. If you have a partner, you may both need time to get used to any changes. There are different ways you can show your partner you care about them. This can include spending time together and showing affection through touching, holding hands or putting an arm around their shoulder. You may also find new ways to share sexual pleasure.
Although the vagina is often removed during pelvic exenteration, the clitoris usually remains. This means you may still have pleasure or orgasms from this area.
After treatment, you may find that your sex life slowly improves. If you continue to have difficulties, ask your specialist nurse or doctor for advice. They can refer you for more specialised support if needed.
As part of pelvic exenteration, your surgeon will remove your reproductive organs. This means that you will not be able become pregnant or have children. If you have not been through the menopause, it will start after pelvic exenteration. Your doctor or a menopause specialist should support you. They will talk to you about how to manage menopausal symptoms.
You can ask to be referred to a fertility specialist before having cancer treatment. You may be able to store your eggs or embryos (fertilised eggs) and use a surrogate in the future. This means that another woman will carry the child in her womb for you. Or you may want to consider adoption in the future.
We have more information about fertility in women.
You may have many different emotions about pelvic exenteration. This can include stress, anger, anxiety and fear.
You may also find it difficult to cope with needing help from others while you are recovering. These are all normal feelings. They are part of adjusting. Talking about how you feel can help.
Sometimes it is easier to talk to someone who does not know you. You could ask your cancer doctor or GP to refer you to a counsellor.
As well as the support available from Macmillan, there are other organisations that can offer you practical and emotional support
IA – Ileostomy and Internal Pouch Association
Bowel Cancer UK
The HPV and Anal Cancer Foundation
College of Sexual and Relationship Therapists
Human Fertilisation and Embryology Authority
Fertility Network UK